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COVID-19 - What Providers Need to Know

Coverage Updates

At Quartz, we're doing all we can to keep you informed during this pandemic. We have several updates on extended timelines for fully insured commercial members.

Extended timelines on coverage with no out-of-pocket costs

  • COVID-19 viral testing: Medically necessary* tests ordered by an in-network provider will continue to be covered through the end of the Public Health Emergency or March 13, 2021, whichever is later. 
  • COVID-19 antibody testing: Medically necessary* tests ordered by an in-network provider will continue to be covered through October 22, 2020, currently the end of the Public Health Emergency.

*Includes tests for members with symptoms, tests for members with known or suspected exposure, contact tracing, and those entering health care facilities for services.

  • Inpatient treatment related to COVID-19: No copay, coinsurance, or deductible when the provider is in our network now extended through October 22, 2020.

Third-party screening tests for employment, school admission, or travel are not covered

As you can see, we cover tests ordered by a provider to meet members’ medical needs. We do not cover screening tests requested by third parties, such as those for employment, school admission, or travel:

  • Tests requested for return to work, school, or participation on a sports team are typically paid for by the organization requesting them or by the person receiving the non-covered service.
  • Tests conducted at public health sites and at-home tests, whether conducted at home or sent to outside labs for analysis, are not covered by Quartz.

Extended timeline for telehealth: e-visits, video visits, virtual visits

An exception to the following: Telehealth coverage for self-funded plans is based on individual plan coverage.

  • No copay, coinsurance, or deductible for telehealth services in our network now extended through December 31, 2020. 
  • This applies to all services that would have otherwise been covered under a member’s plan.

Alternative Care Options

To appropriately waive member cost-sharing for your patients, all provider telehealth claims must have at least one of the telehealth modifiers listed below and listed within our Telehealth Visit Guidelines.

Telehealth Modifiers:

All telemedicine claims must have at least one of these indicators:

Modifiers 

95 - Telemedicine Service

CR - Catastrophe/Disaster Related

CS - Subject to a cost-sharing waiver for testing-related services for COVID-19

GT - Via Interactive Audio and Video Telecommunication System

GQ - Via Asynchronous Telecommunication System

GO - Telehealth Services for Diagnosis Evaluation or Treatment of Symptoms of an Acute Stroke

Traditional True Telehealth Services

Historically in-person services now provided via telehealth

POS 02

POS should equal what it would have been for in-person with modifier 95 to indicate provided by telehealth

Condition Code (UB)
DR - Disaster Related

Commercial and Medicare Claims: 

Quartz will provide coverage for all CPT-identified telemedicine codes and codes published by CMS for fee-for-service Medicare. (Note that ASO customers will make their own member cost-sharing decisions.)

BadgerCare Plus Claims:

Please follow Wisconsin Forward Health coding guidelines.

Resource: CMS and Wisconsin Forward Health coding guidelines.

Visit the ForwardHealth telehealth billing flow chart for BadgerCare Plus members. 

Administrative

  • Prior authorization requirements: Outpatient services related to COVID-19 treatment do not need authorization. Inpatient services will be covered by the inpatient authorization following the normal process.
  • Postponed non-COVID elective services due to COVID-19 needs: All existing prior authorizations generally are approved for 90 days already. Starting March 23, 2020, all new prior authorizations that are approved will be extended to 12/31/20. If you have a prior authorization that was approved prior to March 23 and an extension is needed, please reach out to Quartz Medical Management.
  • COVID-19 prior authorizations/referral and other requirements: Quartz will relax administrative requirements for other services during the COVID-19 patient surge. This includes extending timeframes for notice requirements for emergent admissions for both COVID-19 and other care services. Quartz would like to be notified within a week or so for admissions.
  • Provider enrollment timely filing, appeal deadlines, and other administrative requirements: Under this public health emergency (PHE), Quartz will waive timely filing requirements for dates of service during the PHE for all claims filing so that claims and cost of care are not denied based on failing to meet normal contractual requirements.